Important note: Information in this article was accurate in 2003. The state of the art may have changed since the publication date.
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AIDS Patient Care and STDs (07.03) Vol. 17; No. 7: P.333- 343 - Thursday, October 16, 2003
Joseph Inungu, MD, DrPH; Eileen Malone Beach, PhD: Reid Skeel, PhD
"Because of the high prevalence of HIV among drug users, drug rehabilitation centers must be staffed with HIV experienced health professionals to facilitate HIV case ascertainment and improve HIV management," they stated.
The five major challenges to caring for IDUs are (1) patient's lack of access to health services and nonadherence to treatment; (2) interactions among drugs used to manage HIV and illicit drugs; (3) drug toxicity; (4) increased general health risks among illicit drug abusers; and (5) the clandestine nature of drug use due to negative social consequences (e.g., patients' reluctance to volunteer information because they fear criminal prosecution).
"Every medical encounter with illicit drug users is an opportunity for health professionals to address these challenges and foster healthy behavior changes. To maximize their effectiveness, health professionals must have a clear understanding of the targeted behaviors and their environmental context, including reluctance to openly discuss drug use because of the illegal nature of the drugs as well as concerns about perceived negative opinions of health care providers," the authors explained. Since there is no clear-cut model that adequately addresses issues related to behavior change in IDUs, the writers outlined four behavior-change models and summarized the results of the models in predicting the behaviors of HIV- positive patients.
The health belief model uses the key concepts of perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues for action, and self-efficacy to influence behavior. The theory of reasoned action, a behavior- change model, says intentions or goal setting are the best predictors of behavior, and that the strength of an intention to engage in new behavior may be influenced by an individual's attitude towards success/failure, attitude toward the process of changing, emotional reaction toward change, and normative belief about what important or significant others think he/she should do and by the degree to which he/she wishes to please those people. Social cognitive theory posits that reinforcement along with an individual's expectations of the consequences of behavior determine that behavior. Reinforcement can be accomplished through direct reinforcement, vicarious reinforcement or through self- management. The transtheoretical model suggests that behavior change is a process that involves progressing through six stages: precontemplation, contemplation, preparation, action, maintenance (maintaining behavior change while experiencing relapses), and termination (when overt behavior will never return). Progression through the stages is related to the use of experiential and behavioral strategies, outcome expectancies, and self-efficacy.
The four theoretical constructs, the results of which the authors presented together, showed that perceived susceptibility to HIV infection, perceived social support, subjective norms and self-efficacy positively predicted the use of HIV-preventive behaviors such as condom use, antiretroviral adherence and needle bleaching. Variables such as perceived barriers and attitude did not have predictive effect.
"Coexistence of HIV infection and substance abuse poses a serious threat to society. Continuing marginalization and stigmatization of drug users is counterproductive. Realistic action must be considered to prevent further spread of HIV infection," the writers concluded. "Health care professionals involvement in fostering healthy behavior among their patients is a vital step that needs to be recognized and exploited."
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